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Biniwale M. Neuromuscular components of Apgar score in predicting delivery room respiratory support. Pediatr Res 2024:10.1038/s41390-024-03281-6. [PMID: 38769404 DOI: 10.1038/s41390-024-03281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Manoj Biniwale
- Department of Pediatrics, Keck Medical School of USC, 1200 N State Street, Los Angeles, CA, 90033, USA.
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Midan DA, El-Gendy FM, Bahbah WA, Alamah HY, Elzayat RS. Predictive Ability of Conventional and Combined Apgar Scores versus Neonatal Resuscitation and Adaptation Score in Early Neonatal Assessment. Am J Perinatol 2024; 41:e1647-e1656. [PMID: 36933550 DOI: 10.1055/a-2057-7385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
OBJECTIVE The aim of this study was to assess the Neonatal Resuscitation and Adaptation Score (NRAS) value compared with the conventional and combined Apgar scores in predicting neonatal morbidity and mortality. STUDY DESIGN A prospective cohort study was conducted on 289 neonates delivered at the Menoufia University Hospital. Trained physicians measured conventional Apgar score, combined Apgar score, and NRAS for the neonates at 1 and 5 minutes after delivery in the delivery room. Admitted neonates were followed during their stay to detect any adverse outcomes. RESULTS Morbidities such as the need for neonatal intensive care unit admission, mechanical ventilation, surfactant and inotropes administration, need for extensive phototherapy, intravenous immunoglobulin or exchange transfusion, anemia, metabolic acidosis, abnormal liver and kidney function tests, coagulopathies, hypoglycemia, development of seizures in the first 72 hours of life, and positive changes in cranial ultrasound were significantly higher in neonates who lie within low or moderate NRAS than conventional and combined Apgar scores (p < 0.05). As predictors of mortality, the low and moderate values of the NRAS had higher positive predictive values at 1 (73.91 and 30.61%) and 5 minutes (88.89 and 50.94%) than the conventional Apgar scores at 1 (49.18 and 20.53%), 5 minutes (81.25 and 41.27%) and the combined Apgar scores at 1 (35.63 and 12.45%) and 5 minutes (53.1 and 41.33%). CONCLUSION Our study suggests that the NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity and mortality. Furthermore, a depressed 5-minute NRAS is more predictive of mortality than 1-minute score. KEY POINTS · NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity.. · NRAS is more predictive of mortality than conventional and combined Apgar scores.. · A depressed 5-minute NRAS is more predictive of mortality than 1-minute score..
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Affiliation(s)
- Dina A Midan
- Pediatrics Department, Faculty of Medicine, Menoufia University Hospital, Menoufia, Egypt
| | - Fady M El-Gendy
- Pediatrics Department, Faculty of Medicine, Menoufia University Hospital, Menoufia, Egypt
| | - Wael A Bahbah
- Pediatrics Department, Faculty of Medicine, Menoufia University Hospital, Menoufia, Egypt
| | - Hadeer Y Alamah
- Pediatrics Department, Faculty of Medicine, Menoufia University Hospital, Menoufia, Egypt
| | - Rania S Elzayat
- Pediatrics Department, Faculty of Medicine, Menoufia University Hospital, Menoufia, Egypt
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Michel AD, Lowe NK. Accuracy and Interrater Agreement of Registered Nurses' Assignment of Apgar Scores to Standardized Clinical Vignettes. Clin Nurs Res 2023; 32:452-462. [PMID: 36788427 DOI: 10.1177/10547738231155266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The purpose of our study was to test whether registered nurses assign the correct Apgar score when provided all pertinent data, whether they assign an Apgar score even if all pertinent data are not provided, and to evaluate the Apgar score's interrater agreement. We conducted a REDCap survey and provided nurses with color photograph/vignette combinations of neonates, some of which lacked pertinent data points needed to correctly assign Apgar scores. Over 90% of study participants assigned Apgar scores even if data points for heart rate or respiratory effort were omitted. Participants' correct assignment of the component score for respiratory effort was affected by the description of the respiratory effort and whether neonatal heart rate was known. Interrater agreement was generally low to moderate. Our findings are consistent with earlier findings and support the conclusion that the Apgar score requires significant revision or needs to be retired and replaced.
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Kaufmann M, Mense L, Springer L, Dekker J. Tactile stimulation in the delivery room: past, present, future. A systematic review. Pediatr Res 2022:10.1038/s41390-022-01945-9. [PMID: 35124690 DOI: 10.1038/s41390-022-01945-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022]
Abstract
In current resuscitation guidelines, tactile stimulation is recommended for infants with insufficient respiratory efforts after birth. No recommendations are made regarding duration, onset, and method of stimulation. Neither is mentioned how tactile stimulation should be applied in relation to the gestational age. The aim was to review the physiological mechanisms of respiratory drive after birth and to identify and structure the current evidence on tactile stimulation during neonatal resuscitation. A systematic review of available data was performed using PubMed, covering the literature up to April 2021. Two independent investigators screened the extracted references and assessed their methodological quality. Six studies were included. Tactile stimulation management, including the onset of stimulation, overall duration, and methods as well as the effect on vital parameters was analyzed and systematically presented. Tactile stimulation varies widely between, as well as within different centers and no consensus exists which stimulation method is most effective. Some evidence shows that repetitive stimulation within the first minutes of resuscitation improves oxygenation. Further studies are warranted to optimize strategies to support spontaneous breathing after birth, assessing the effect of stimulating various body parts respectively within different gestational age groups.
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Affiliation(s)
- M Kaufmann
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany.
| | - L Mense
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany
| | - L Springer
- Division of Neonatology, Department of Paediatrics, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - J Dekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
BACKGROUND The Apgar score is the most common score used to quantify neonatal status after birth. It is routinely used in clinical practice and research. However, since its introduction there have been significant changes in peripartum and neonatal management, our understanding of neonatal physiology, and changes in data analysis capabilities. PURPOSE To assess the Apgar score's reliability and validity in the context of today's clinical and research environments. METHOD PubMed was searched using the term "Apgar." Just over 22,000 titles were identified. Full-text articles were obtained if they addressed the Apgar score's use, reliability, and validity, or if the score was a primary outcome measure. This was followed by a hand search using the same criteria. The 505 identified articles build the basis for this discussion of the Apgar score's reliability and validity. FINDINGS Multiple positive and negative aspects of the Apgar score's reliability and validity were identified. Some facets needed to evaluate reliability and validity do not seem to have been addressed in the literature. Overall, the identified concerns can introduce bias into outcomes obtained via the use of the Apgar score in both clinical practice and research. IMPLICATIONS FOR PRACTICE The Apgar score is no longer used to determine neonatal management in the delivery room. IMPLICATIONS FOR RESEARCH The use of the Apgar score in research may introduce bias into outcomes. As discussed in the Video Abstract, researchers need to address and improve the score's weaknesses or consider developing a new tool better suited to today's research needs. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=45.
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Olateju S, Osinaike B, Salami O, Adetoye A, Fatungase O, Aaron O, Faponle A, on behalf. Anaesthetic complications during elective caesarean delivery and outcomes: A nigerian multi-centre cohort study. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Niemuth M, Küster H, Simma B, Rozycki H, Rüdiger M, Solevåg AL. A critical appraisal of tools for delivery room assessment of the newborn infant. Pediatr Res 2021:10.1038/s41390-021-01896-7. [PMID: 34969993 DOI: 10.1038/s41390-021-01896-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Assessment of an infant's condition in the delivery room represents a prerequisite to adequately initiate medical support. In her seminal paper, Virginia Apgar described five parameters to be used for such an assessment. However, since that time maternal and neonatal care has changed; interventions were improved and infants are even more premature. Nevertheless, the Apgar score is assigned to infants worldwide but there are concerns about low interobserver reliability, especially in preterm infants. Also, resuscitative interventions may preclude the interpretation of the score, which is of concern when used as an outcome parameter in delivery room intervention studies. Within the context of these changes, we performed a critical appraisal on how to assess postnatal condition of the newborn including the clinical parameters of the Apgar score, as well as selected additional parameters and a proposed new scoring system. The development of a new scoring system that guide clinicians in assessing infants and help to decide how to support postnatal adaptation is discussed. IMPACT: This critical paper discusses the reliability of the Apgar score, as well as additional parameters, in order to improve assessment of a newborn's postnatal condition. A revised neonatal scoring system should account for infant maturity and the interventions administered. Delivery room assessment should be directed toward determining how much medical support is needed and how the infant responds to these interventions.
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Affiliation(s)
- Mara Niemuth
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Helmut Küster
- Clinic for Pediatric Cardiology, Intensive Care and Neonatology, University Medical Center Göttingen, Göttingen, Germany
| | - Burkhard Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Henry Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anne Lee Solevåg
- The Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
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Roland R. Wauer (1942-2020): neonatologist, scientist, teacher and visionary. Pediatr Res 2021; 90:703-704. [PMID: 33446926 DOI: 10.1038/s41390-020-01338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022]
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Thangaswamy CR, Kundra P, Velayudhan S, Aswini LN, Veena P. Influence of anaesthetic technique on maternal and foetal outcome in category 1 caesarean sections - A prospective single-centre observational study. Indian J Anaesth 2018; 62:844-850. [PMID: 30532319 PMCID: PMC6236792 DOI: 10.4103/ija.ija_406_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome. Methods: Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score <7, umbilical cord blood pH <7.2, neonatal intensive care unit admission or death) was created for adverse neonatal outcome. Logistic regression was done to assess the influence of confounding factors on the occurrence of adverse neonatal outcome. Results: Of 123 patients who underwent category 1 cesarean section, 114 patients were included for analysis. The DDI and UIDT were comparable. One and 5-min Apgar scores were significantly lower in the group general anaesthesia (GA) than in the group spinal anaesthesia (SA). The umbilical cord blood pH was comparable (7.21 ± 0.15 vs 7.25 ± 0.11 in groups GA and SA, respectively). Neonatal intensive care admission and maternal outcome were comparable in both the groups. Subgroup analysis of patients with foetal heart rate of less than 100 showed that group GA had significantly lower 1-min Apgar scores and umbilical cord blood pH and significantly more neonatal admission and mortality. Binominal logistic regression showed that group GA (odds ratio 2.9, 95% confidence intervals 1.27-6.41) and gestational age were independently associated with adverse neonatal outcome. Conclusion: GA for category 1 CS was associated with increased incidence of adverse neonatal outcome.
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Affiliation(s)
- Chitra Rajeswari Thangaswamy
- Departments of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | - Pankaj Kundra
- Departments of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | - Savitri Velayudhan
- Department of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | | | - P Veena
- Department of Obstetrics and Gynaecology Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
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Cnattingius S, Norman M, Granath F, Petersson G, Stephansson O, Frisell T. Apgar Score Components at 5 Minutes: Risks and Prediction of Neonatal Mortality. Paediatr Perinat Epidemiol 2017; 31:328-337. [PMID: 28493508 DOI: 10.1111/ppe.12360] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Apgar score consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and colour. Although the Apgar score has been used for 60 years, the specific contribution of the Apgar score components with respect to risks and prediction of neonatal mortality remains unknown. Likewise, the value of reduced scores (including less than five Apgar score components) has rarely been investigated. METHODS In a population-based cohort study of 148 765 liveborn singleton infants in Sweden 2008-2013, we investigated components of Apgar score at 5 min with respect to relative risks and prediction (using ROC curves, sensitivity, and positive predictive values) of neonatal mortality. RESULTS Reduced values (0-1) of heart rate, respiratory effort, and colour were independently associated with increased relative risks of neonatal mortality. For the full Apgar score, the sensitivity and positive predictive values of neonatal mortality (cut-off ≤3) were by gestational age: ≤31 weeks: 56.1% and 49.2%; 32-36 weeks: 25.0% and 18.2%; and ≥37 weeks: 35.2% and 9.3%, respectively. When only heart rate and respiratory effort were considered (range 0-4; cut-off ≤2), corresponding values were 66.7% and 34.9%; 37.5% and 13.0%; and 46.3% and 7.6%, respectively. CONCLUSIONS A reduced Apgar score has generally the same predictability of neonatal mortality as the full Apgar score. The full Apgar score or reduced scores may be better predictors of neonatal mortality in very preterm infants (≤31 weeks) than in infants with longer gestations.
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Affiliation(s)
- Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Petersson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Thomas Frisell
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Siddiqui A, Cuttini M, Wood R, Velebil P, Delnord M, Zile I, Barros H, Gissler M, Hindori-Mohangoo AD, Blondel B, Zeitlin J. Can the Apgar Score be Used for International Comparisons of Newborn Health? Paediatr Perinat Epidemiol 2017. [PMID: 28621463 DOI: 10.1111/ppe.12368] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Apgar score has been shown to be predictive of neonatal mortality in clinical and population studies, but has not been used for international comparisons. We examined population-level distributions in Apgar scores and associations with neonatal mortality in Europe. METHODS Aggregate data on the 5 minute Apgar score for live births and neonatal mortality rates from countries participating in the Euro-Peristat project in 2004 and 2010 were analysed. Country level associations between the Apgar score and neonatal mortality were assessed using the Spearman rank correlation coefficient. RESULTS Twenty-three countries or regions provided data on Apgar at 5 minutes, covering 2 183 472 live births. Scores <7 ranged from 0.3% to 2.4% across countries in 2004 and 2010 and were correlated over time (ρ = 0.88, P < 0.01). There were large differences in healthy baby scores: scores of 10 ranged from 8.8% to 92.7% whereas scores of 9 or 10 ranged from 72.9% to 96.8%. Countries more likely to score 10 s, as opposed to 9 s, for healthy babies had lower proportions of Apgar <7 (ρ = -0.43, P = 0.04). Neonatal mortality rates were weakly correlated with Apgar score <7 (ρ = -0.06, P = 0.61), but differences over time in these two indicators were correlated (ρ =0.56, P = 0.02). CONCLUSIONS Large variations in the distribution of Apgar scores likely due to national scoring practices make the Apgar score an unsuitable indicator for benchmarking newborn health across countries. However, country-level trends over time in the Apgar score may reflect real changes and merit further investigation.
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Affiliation(s)
- Ayesha Siddiqui
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Rachel Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Marie Delnord
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France
| | - Irisa Zile
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland
| | - Ashna D Hindori-Mohangoo
- Department Child Health, Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Leiden, the Netherlands.,Faculty of Medical Sciences, Department Public Health, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France
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Jeganathan R, Karalasingam SD, Hussein J, Allotey P, Reidpath DD. Factors associated with recovery from 1 minute Apgar score <4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010-2012. BMC Pregnancy Childbirth 2017; 17:110. [PMID: 28390414 PMCID: PMC5385027 DOI: 10.1186/s12884-017-1293-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/23/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The neonatal Apgar score at 5 min has been found to be a better predictor of outcomes than the Apgar score at 1 min. A baby, however, must pass through the first minute of life to reach the fifth. There has been no research looking at predictors of recovery (Apgar scores ≥7) by 5 min in neonates with 1 min Apgar scores <4. METHODS An analysis of observational data was conducted using live, singleton, term births recorded in the Malaysian National Obstetrics Registry between 2010 and 2012. A total of 272,472 live, singleton, term births without congential anomalies were recorded, of which 1,580 (0.59%) had 1 min Apgar scores <4. Descriptive methods and bi- and multi-variable logistic regression were used to identify risk factors associated with recovery (5 min Apgar score ≥7) from 1 min Apgar scores <4. RESULTS Less than 1% of births have a 1 min Apgar scores <4. Only 29.4% of neonates with 1 min Apgar scores <4 recover to a 5 min Apgar score ≥7. Among uncomplicated vaginal deliveries, after controlling for other factors, deliveries by a doctor of neonates with a 1 min Apgar score <4 had odds of recovery 2.4 times greater than deliveries of neonates with a 1 min Apgar score <4 by a nurse-midwife. Among deliveries of neonates with a 1 min Apgar score <4 by doctors, after controlling for other factors, planned and unplanned CS was associated with better odds of recovery than uncomplicated vaginal deliveries. Recovery was also associated with maternal obesity, and there was some ethnic variation - in the adjusted analysis indigenous (Orang Asal) Malaysians had lower odds of recovery. CONCLUSIONS A 1 min Apgar score <4 is relatively rare, and less than a third recover by five minutes. In those newborns the qualification of the person performing the delivery and the type of delivery are independent predictors of recovery as is maternal BMI and ethnicity. These are associations only, not necessarily causes, and they point to potential areas of research into health systems factors in the labour room, as well as possible biological and cultural factors.
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Affiliation(s)
- Ravichandran Jeganathan
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Shamala D. Karalasingam
- National Obstetric Registry, Clinical Research Centre, Ministry of Health Malaysia, Kualar Lumpur, Malaysia
| | - Julia Hussein
- Immpact, University of Aberdeen, Aberdeen, Scotland UK
| | - Pascale Allotey
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Bandar Sunway, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 46150 Malaysia
| | - Daniel D. Reidpath
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Bandar Sunway, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 46150 Malaysia
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van Tetering AAC, van de Ven J, Fransen AF, Dieleman JP, van Runnard Heimel PJ, Oei SG. Risk factors of incomplete Apgar score and umbilical cord blood gas analysis: a retrospective observational study. J Matern Fetal Neonatal Med 2016; 30:2539-2544. [PMID: 27884069 DOI: 10.1080/14767058.2016.1256985] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether incomplete umbilical cord blood gas (UCBG) analysis occurs more often than the incomplete reporting of the Apgar score, and risk factors associated with the incomplete values. METHODS A total of 8824 infants born alive after 26 weeks' gestation between January 2009 and April 2013 were included. We extracted data on five-minute Apgar score, UCBG analysis, gestational age, mode of delivery, time of delivery and multiple pregnancy. Univariate and multivariable logistic regression analyses were performed. RESULTS Five-minute Apgar score was incomplete in 15 cases (0.2%) and UCBG analysis in 1960 cases (22.2%), p < 0.05. Incomplete UCBG analysis was significantly more likely to occur in situations with Apgar score below seven (Odds ratio (OR) 1.68, 95% CI;1.29-2.19), gestational age between 26 to 27 6/7 and 28 to 31 6/7 weeks (OR 3.14, 95% CI; 2.13-4.62 and OR 1.91, 95% CI; 1.57-2.32), cesarean section (OR 1.31, 95% CI; 1.11-1.55), and multiple pregnancy (OR 2.02, 95% CI; 1.69-2.43). Deliveries during night time had a lower risk of incomplete UCBG analysis (OR 0.78, 95% CI; 0.69-0.88). CONCLUSIONS Measuring five-minute Apgar score generated less incomplete data compared with UCBG analysis. The risk factors associated with incomplete UCBG analysis were noted. Study outcomes with UCBG analysis as neonatal assessment tool should be interpreted with caution.
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Affiliation(s)
- Anne A C van Tetering
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , The Netherlands
| | - Joost van de Ven
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , The Netherlands
| | - Annemarie F Fransen
- b Department of Obstetrics and Gynaecology , Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Jeanne P Dieleman
- c MMC Academy, Máxima Medical Center , Veldhoven , The Netherlands , and
| | | | - S Guid Oei
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , The Netherlands.,d Department of Electrical Engineering , Eindhoven University of Technology , Eindhoven , The Netherlands
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Dalili H, Sheikh M, Hardani AK, Nili F, Shariat M, Nayeri F. Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes. PLoS One 2016; 11:e0149464. [PMID: 26871908 PMCID: PMC4752486 DOI: 10.1371/journal.pone.0149464] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/31/2016] [Indexed: 02/02/2023] Open
Abstract
Objectives Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar. Methods This prospective cohort study evaluated 942 neonates (166 very preterm, 233 near term, and 543 term) admitted to a tertiary referral hospital. At 1- and 5-minutes after delivery, the Conventional and Combined Apgar scores were recorded. The neonates were followed, and the following information was recorded: the occurrence of severe hyperbilirubinemia requiring medical intervention, the requirement for mechanical ventilation, the occurrence of intraventricular hemorrhage (IVH), and neonatal mortality. Results Before adjusting for the potential confounders, a low Conventional (<7) or Combined (<10) Apgar score at 5-minutes was associated with adverse neonatal outcomes. However, after adjustment for the gestational age, birth weight and the requirement for neonatal resuscitation in the delivery room, a depressed 5-minute Conventional-Apgar score lost its significant associations with all the measured adverse outcomes; after the adjustments, a low 5-minute Combined-Apgar score remained significantly associated with the requirement for mechanical ventilation (OR,18.61; 95%CI,6.75–51.29), IVH (OR,4.8; 95%CI,1.91–12.01), and neonatal mortality (OR,20.22; 95%CI,4.22–96.88). Additionally, using Receiver Operating Characteristics (ROC) curves, the area under the curve was higher for the Combined-Apgar than the Conventional-Apgar for the prediction of neonatal mortality and the measured morbidities among all the admitted neonates and their gestational age subgroups. Conclusions The newly proposed Combined-Apgar score can be a good predictor of neonatal mortality and morbidity in the admitted neonates, regardless of their gestational age and resuscitation status. It is also superior to the Conventional-Apgar in predicting adverse neonatal outcomes in very preterm, near term and term neonates.
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Affiliation(s)
- Hosein Dalili
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Amir Kamal Hardani
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firouzeh Nili
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nayeri
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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15
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Krajčinović SS, Doronjski A, Barišić N, Stojanović V. Risk Factors for Neonatal Sepsis and Method for Reduction of Blood Culture Contamination. Malawi Med J 2015; 27:20-4. [PMID: 26137194 DOI: 10.4314/mmj.v27i1.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND False-positive blood cultures findings may lead to a falsely increased morbidity and increased hospital costs. METHOD The survey was conducted as retrospective - prospective study and included 239 preterm infants (born before 37 weeks of gestation) who were treated in Neonatal Intensive Care Unit (NICU) in Institute for Child and Youth Health Care of Vojvodina during one year (January 1st, 2012 to December 31st, 2012). The retrospective part of the study focused on examination of incidence of neonatal sepsis and determination of risk factors. In the prospective part of the study infants were sub-divided into two groups: Group 1- infants hospitalized in NICU during the first 6 months of the study; blood cultures were taken by the "clean technique" and checklists for this procedure were not taken. Group 2- neonates hospitalized in NICU during last 6 months of the study; blood cultures were taken by "sterile technique" and checklists for this procedure were taken. RESULTS The main risk factors for sepsis were prelabor rupture of membranes, low gestational age, low birth weight, mechanical ventilation, umbilical venous catheter placement, and abdominal drainage. Staphylococcus aureus and coagulase negative Staphylococcus were the most frequently isolated microorganisms in false-positive blood samples. CONCLUSIONS Education of employees, use of checklists and sterile sets for blood sampling, permanent control of false positive blood cultures, as well as regular and routine monthly reports are crucial for successful reduction of contamination rates.
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Affiliation(s)
- S S Krajčinović
- Intensive Care Unit, Institute for Child and Youth Health care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia
| | - A Doronjski
- Intensive Care Unit, Institute for Child and Youth Health care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia ; Medical faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - N Barišić
- Intensive Care Unit, Institute for Child and Youth Health care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia ; Medical faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - V Stojanović
- Intensive Care Unit, Institute for Child and Youth Health care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia ; Medical faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
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16
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Jurdi SR, Jayaram A, Sima AP, Hendricks Muñoz KD. Evaluation of a Comprehensive Delivery Room Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score: A Pilot Study. Glob Pediatr Health 2015; 2:2333794X15598293. [PMID: 27335974 PMCID: PMC4784623 DOI: 10.1177/2333794x15598293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the interrater reliability and perceived importance of components of a developed neonatal adaption score, Neonatal Resuscitation Adaptation Score (NRAS), for evaluation of resuscitation need in the delivery room for extremely premature to term infants. Similar to the Apgar, the NRAS highest score was 10, but greater weight was given to respiratory and cardiovascular parameters. Evaluation of provider (N = 17) perception and scoring pattern was recorded for 5 clinical scenarios of gestational ages 23 to 40 weeks at 1 and 5 minutes and documenting NRAS and Apgar score. Providers assessed the tool twice within a 1-month interval. NRAS showed superior interrater reliability (P < .001) and respiratory component reliability (P < .001) for all gestational ages compared to the Apgar score. These findings identify an objective tool in resuscitation assessment of infants, especially those of smaller gestation age, allowing for greater discrimination of postbirth transition in the delivery room.
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Affiliation(s)
- Shadi R Jurdi
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Archana Jayaram
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Adam P Sima
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Dalili H, Nili F, Sheikh M, Hardani AK, Shariat M, Nayeri F. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PLoS One 2015; 10:e0122116. [PMID: 25811904 PMCID: PMC4374718 DOI: 10.1371/journal.pone.0122116] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/20/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes. METHODS This prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure. RESULTS The Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01). CONCLUSIONS The newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates.
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Affiliation(s)
- Hosein Dalili
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firouzeh Nili
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kamal Hardani
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nayeri
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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Comparison of the Four Proposed Apgar Scoring Systems in the Assessment of Birth Asphyxia and Adverse Early Neurologic Outcomes. PLoS One 2015. [DOI: 10.1371/journal.pone.0122116
'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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Rüdiger M, Braun N, Aranda J, Aguar M, Bergert R, Bystricka A, Dimitriou G, El-Atawi K, Ifflaender S, Jung P, Matasova K, Ojinaga V, Petruskeviciene Z, Roll C, Schwindt J, Simma B, Staal N, Valencia G, Vasconcellos MG, Veinla M, Vento M, Weber B, Wendt A, Yigit S, Zotter H, Küster H. Neonatal assessment in the delivery room--Trial to Evaluate a Specified Type of Apgar (TEST-Apgar). BMC Pediatr 2015; 15:18. [PMID: 25884954 PMCID: PMC4374498 DOI: 10.1186/s12887-015-0334-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/13/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Since an objective description is essential to determine infant's postnatal condition and efficacy of interventions, two scores were suggested in the past but weren't tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone. METHODS Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated. RESULTS Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28(6/7) ± 2(3/7) weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively. CONCLUSION The Combined-Apgar allows a more appropriate description of infant's condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions. TRIAL REGISTRATION clinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.
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Affiliation(s)
- Mario Rüdiger
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
| | - Nicole Braun
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
| | - Jacob Aranda
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Marta Aguar
- Division of Neonatology, University & Polytechnic Hospital La Fe, 46009, Valencia, Spain.
| | - Renate Bergert
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
| | - Alica Bystricka
- Faculty Hospital, Department of Neonatology, 94001, Nové Zámky, Slovakia.
| | - Gabriel Dimitriou
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Patras Medical School, Rio, Patras, 26500, Greece.
| | - Khaled El-Atawi
- Neonatal Intensive Care Unit, Department of Pediatrics, Latifa Hospital, Dubai Health Authority, Government of Dubai, United Arab Emirates.
| | - Sascha Ifflaender
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
| | - Philipp Jung
- Clinic for Pediatrics, University Hospital Schleswig-Holstein, Campus Lübeck, 23562, Lübeck, Germany.
| | - Katarina Matasova
- Clinic of Neonatology, Jessenius Faculty of Medicine Martin, Comenius University Bratislava, University Hospital in Martin, 03601, Martin, Slovakia.
| | - Violeta Ojinaga
- División de Neonatología, Instituto Nacional de Perinatología, 11000, México, D.F, México.
| | - Zita Petruskeviciene
- Department of Neonatology, Kaunas University of Medicine, Kaunas, 44307, Lithuania.
| | - Claudia Roll
- Department of Neonatology and Pediatric Intensive Care, Vest Children's Hospital Datteln, University Witten/Herdecke, 45711, Datteln, Germany.
| | - Jens Schwindt
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, 1090, Vienna, Austria.
| | - Burkhard Simma
- Department of Pediatrics, University Teaching Hospital, 6807, Feldkirch, Austria.
| | - Nanette Staal
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, 1090, Vienna, Austria.
| | - Gloria Valencia
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | | | - Maie Veinla
- Department of Neonatology, Children's Clinic of Tartu University Hospital, 51014, Tartu, Estonia.
| | - Máximo Vento
- Division of Neonatology, University & Polytechnic Hospital La Fe, 46009, Valencia, Spain.
| | - Benedikt Weber
- Clinic for Neonatology, University Hospital Charité Berlin, Campus Virchow, 13353, Berlin, Germany.
| | - Anke Wendt
- Clinic for Neonatology, University Hospital Charité Berlin, Campus Mitte, 10117, Berlin, Germany.
| | - Sule Yigit
- Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
| | - Heinz Zotter
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, 8036, Graz, Austria.
| | - Helmut Küster
- Children's Hospital, University of Göttingen, 37099, Göttingen, Germany.
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20
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Affiliation(s)
- Mario Rüdiger
- Department of Neonatology and Pediatric Intensive Care, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Dimitrios Konstantelos
- Department of Neonatology and Pediatric Intensive Care, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Terrell ML, Hartnett KP, Lim H, Wirth J, Marcus M. Maternal exposure to brominated flame retardants and infant Apgar scores. CHEMOSPHERE 2015; 118:178-86. [PMID: 25203650 PMCID: PMC4249940 DOI: 10.1016/j.chemosphere.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 05/19/2023]
Abstract
Brominated flame retardants (BFRs) and other persistent organic pollutants have been associated with adverse health outcomes in humans and may be particularly toxic to the developing fetus. We investigated the association between in utero polybrominated biphenyl (PBB) and polychlorinated biphenyl (PCB) exposures and infant Apgar scores in a cohort of Michigan residents exposed to PBB through contaminated food after an industrial accident. PBB and PCB concentrations were measured in serum at the time the women were enrolled in the cohort. PBB concentrations were also estimated at the time of conception for each pregnancy using a validated elimination model. Apgar scores, a universal measure of infant health at birth, measured at 1 and 5min, were taken from birth certificates for 613 offspring born to 330 women. Maternal PCB concentrations at enrollment were not associated with below-median Apgar scores in this cohort. However, maternal PBB exposure was associated with a dose-related increase in the odds of a below-median Apgar score at 1min and 5min. Among infants whose mothers had an estimated PBB at conception above the limit of detection of 1 part per billion (ppb) to <2.5ppb, the odds ratio=2.32 (95% CI: 1.22-4.40); for those with PBB⩾2.5ppb the OR=2.62 (95% CI: 1.38-4.96; test for trend p<0.01). Likewise, the odds of a below-median 5min Apgar score increased with higher maternal PBB at conception. It remains critical that future studies examine possible relationships between in utero exposures to brominated compounds and adverse health outcomes.
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Affiliation(s)
- Metrecia L Terrell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Kathleen P Hartnett
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Hyeyeun Lim
- Departments of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, TX, United States
| | - Julie Wirth
- Departments of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States; Division of Environmental Health, Bureau of Epidemiology, Michigan Department of Community Health, Lansing, MI, United States
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Sodium bicarbonate--the swings and roundabouts will not stop without randomized evidence. Crit Care Med 2013; 41:2242-3. [PMID: 23979378 DOI: 10.1097/ccm.0b013e31828e9098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boulkedid R, Sibony O, Goffinet F, Fauconnier A, Branger B, Alberti C. Quality indicators for continuous monitoring to improve maternal and infant health in maternity departments: a modified Delphi survey of an international multidisciplinary panel. PLoS One 2013; 8:e60663. [PMID: 23577143 PMCID: PMC3618223 DOI: 10.1371/journal.pone.0060663] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 03/01/2013] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Measuring the quality of inpatient obstetrical care using quality indicators is becoming increasingly important for both patients and healthcare providers. However, there is no consensus about which measures are optimal. We describe a modified Delphi method to identify a set of indicators for continuously monitoring the quality of maternity care by healthcare professionals. METHODOLOGY AND MAIN FINDINGS An international French-speaking multidisciplinary panel comprising 22 obstetricians-gynaecologists, 12 midwives, and 1 paediatrician assessed potential indicators extracted from a medical literature search, using a two-round Delphi procedure followed by a physical meeting. Each panellist rated each indicator based on validity and feasibility. In the first round, 35 panellists from 5 countries and 20 maternity units evaluated 26 indicators including 15 related to the management of the overall population of pregnant women, 3 to the management of women followed from the first trimester of pregnancy, 2 to the management of low-risk pregnant women, and 6 to the management of neonates. 25 quality indicators were kept for next step. In the second round, 27 (27/35: 77%) panellists selected 17 indicators; the remaining 8 indicators were discussed during a physical meeting. The final set comprised 18 indicators. CONCLUSION A multidisciplinary panel selected indicators that reflect the quality of obstetrical care. This set of indicators could be used to assess and monitor obstetrical care, with the goal of improving the quality of care in maternity units.
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Affiliation(s)
- Rym Boulkedid
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France.
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Bashambu MT, Whitehead H, Hibbs AM, Martin RJ, Bhola M. Evaluation of interobserver agreement of apgar scoring in preterm infants. Pediatrics 2012; 130:e982-7. [PMID: 23008464 DOI: 10.1542/peds.2012-0368] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Apgar scoring is accepted by medical professionals both as a measure of the infant's clinical status and the infant's response to resuscitation. Recent studies, however, have suggested significant variability when used for scoring preterm infants. We hypothesized that agreement in Apgar scoring would improve with increasing gestational age and at low levels of respiratory support. We also hypothesized that grimace and muscle tone would demonstrate the least agreement. METHODS Neonatologists from the Perinatal Section of the American Academy of Pediatrics were presented with 4 film clip cases via a secure online survey: (1) full-term infant in room air; (2) 28 weeks' gestation infant with continuous positive airway pressure; (3) 28 weeks' gestation infant intubated; and (4) 24 weeks' gestation infant intubated. Participants were shown 30-second clips at 1, 5, and 10 minutes of life and were asked to provide Apgar scores. κ coefficients were used to compare agreement for each component. RESULTS A total of 335 neonatologists participated in the survey. κ coefficients in the full-term infant for respiratory effort (0.94, 0.91), grimace (0.91, 0.90), and muscle tone (0.91, 0.89) demonstrated almost perfect agreement at 1 and 5 minutes. For preterm infants, respiratory effort (range: 0.07-0.40), muscle tone (range: 0.10-0.75), and grimace (range: 0.11-0.71) all demonstrated disagreement at 1, 5, and 10 minutes of life unless the infants were apneic and limp. CONCLUSIONS An improved delivery room score that decreases variability among medical care professionals is needed to accurately reflect the clinical status of preterm infants.
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Affiliation(s)
- Monuj T Bashambu
- Department of Pediatrics, Division of Neonatology, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, RBC Suite 3100, Cleveland, OH 44106, USA.
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The 5-minute Apgar score: survival and short-term outcomes in extremely low-birth-weight infants. J Perinat Neonatal Nurs 2012; 26:166-71. [PMID: 22551865 DOI: 10.1097/jpn.0b013e31825277e9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Apgar score is a standardized tool for evaluating newborns in the delivery room. Despite its long history and widespread use, debate remains over its reliability of predicting neonatal outcomes, especially in extremely low-birth-weight premature infants. The aim of the study was to examine the relationship between the 5-minute Apgar score of extremely low-birth-weight infants, as it relates to survival and morbidities associated with prematurity and length of hospital stay. A retrospective query of the Alere neonatal database from 2001 to 2011 examined all infants less than 32 weeks' gestation and less than 1000-g birth weight. The 5-minute Apgar score was divided into 2 groups, score of 4 or greater or less than 4. The study compared results of the 5-minute Apgar score and associated morbidities in surviving infants. Statistical analyses included chi-square, Fisher exact test, t test, and multivariate regression. The sample consisted of 3898 infants with an 86.4% (n = 3366) survival rate. Controlling for gestational age and birth weight, surviving infants with a 5-minute Apgar score of less than 4 were more likely to demonstrate nonintact survival. Infants with a low 5-minute Apgar score have greater risk for mortality and morbidities associated with prematurity.
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Rüdiger M, Braun N, Gurth H, Bergert R, Dinger J. Preterm resuscitation I: clinical approaches to improve management in delivery room. Early Hum Dev 2011; 87:749-53. [PMID: 21920678 DOI: 10.1016/j.earlhumdev.2011.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Delivery room (DR-) management has a great potential to optimise quality of long term outcome in extremely preterm infants. However, a new conceptual framework that focuses on an individualised 'support of transition' rather than on 'resuscitation' is necessary. Video-recordings of DR-management represent a valuable tool to improve care. Recording combined with a structured feed-back should be introduced in step-wise approach in clinical routine. To describe the postnatal condition of groups of infants or to compare interventions in a research setting, a numerical score-- representing the sum of several objective findings--is required. The conventional Apgar-Score has severe limitations that restrict its applicability. The Specified-Apgar allows an assessment of infant's condition independent of interventions and regardless of gestational age. The Expanded-Apgar quantifies the interventions needed to achieve the condition described by the Specified-Apgar. In summary, beside a new conceptual framework an individualised monitoring and an objective assessment of DR-management are required.
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Affiliation(s)
- Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, Children's Clinic of the University Hospital Carl Gustav Carus, Fetscherstrasse 74, Dresden, Germany.
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Jiang ZD, Wilkinson AR. Relationship between brainstem auditory function during the neonatal period and depressed Apgar score. J Matern Fetal Neonatal Med 2010; 23:973-9. [PMID: 19903110 DOI: 10.3109/14767050903410672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To understand whether infants with depressed Apgar scores are at high risk of brainstem auditory impairment, we examined the relationship between brainstem auditory function during the neonatal period and depressed Apgar score. METHODS Brainstem auditory evoked responses (BAERs) were recorded from day 1 to day 30 in 145 term infants with Apgar scores < or = 6. RESULTS For 1-min Apgar score none of BAER response wave latencies and interpeak intervals during the first 15 days correlated significantly with the score. On day 30, all wave latencies but no intervals correlated negatively with the score (all p < 0.05). For 5-min Apgar score, only on day 3 wave V latency and I-V and III-V intervals correlated negatively with the score (all p < 0.05). For 10-min Apgar score, only III-V interval correlated negatively with the score (p < 0.05). No correlation was found between BAER variables on any other days and 5 and 10-min Apgar scores. Wave V latency and I-V and III-V intervals on day 3 were all significantly longer in infants with 5-min Apgar scores < or = 6 than in those with scores > 6. CONCLUSIONS During the neonatal period, only on day 3 after birth a depressed 5-min Apgar score is an indicator associated with central auditory impairment. A depressed 1-min score may be associated with later peripheral auditory impairment.
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Affiliation(s)
- Ze Dong Jiang
- Neonatal Unit, Department of Paediatrics, John Radcliffe Hospital, Headington, University of Oxford, Oxford, UK.
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Abstract
AIM To investigate the relationship between low Apgar score and neonatal mortality in preterm neonates. METHODS Infant birth and death certificate data from the US National Center for Health Statistics for 2001-2002 were analysed. Primary outcome was 28-day mortality for 690, 933 neonates at gestational ages 24-36 weeks. Mortality rates were calculated for each combination of gestational age and 5-min Apgar score. Relative risks of mortality, by high vs. low Apgar score, were calculated for each age. RESULTS Distribution of Apgar scores depended on gestational age, the youngest gestational ages having higher proportions of low Apgar scores. Median Apgar score ranged from 6 at 24 weeks, to 9 at 30-36 weeks gestation. The relative risk of death was significantly higher at Apgar scores 0-3 vs. 7-10, including at the youngest gestational ages, ranging from 3.1 (95% confidence interval 2.9, 3.4) at 24 weeks to 18.5 (95% confidence interval 15.7, 21.8) at 28 weeks. CONCLUSION Low Apgar score was associated with increased mortality in premature neonates, including those at 24-28 weeks gestational age, and may be a useful tool for clinicians in assessing prognosis and for researchers as a risk prediction variable.
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Affiliation(s)
- Henry Chong Lee
- Division of Neonatology, University of California, San Francisco, CA, USA.
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